Solid-pseudopapillary tumor of the pancreas: A single center experience

open6noAim of this study was to review the institutional experience of solid-pseudopapillary tumors of the pancreas with particular attention to the problems of preoperative diagnosis and treatment. From 1997 to 2013, SPT was diagnosed in 18 patients among 451 pancreatic cystic neoplasms (3.7%). All patients underwent preoperative abdominal ultrasound, computed assisted tomography, and tumor markers (CEA and CA 19-9) determinations. In some instances, magnetic resonance, positron emission tomography, and endoscopic ultrasound with aspiration cytology were performed. There were two males and 16 females. Serum CA 19-9 was slightly elevated in one case. Preoperative diagnosis was neuroendocrine tumor (n = 2), mucinous tumor (n = 2), and SPT (n = 14). Two patients underwent previous operation before referral to our department: one explorative laparotomy and one enucleation of SPT resulting in surgical margins involvement. All patients underwent pancreatic resection associated with portal vein resection (n = 1) or liver metastases (n = 1). One patient died of metastatic disease, 77 months after operation, and 17 are alive and free with a median survival time of 81.5 months (range 36-228 months). Most of SPT can be diagnosed by CT or MRI, and the role of other diagnostic tools is very limited. We lack sufficient information regarding clinicopathologic features predicting prognosis. Caution is needed when performing limited resection, and long and careful follow-up is required for all patients after surgery.openBeltrame, Valentina; Pozza, Gioia; Dalla Bona, Enrico; Fantin, Alberto; Valmasoni, Michele; Sperti, CosimoBeltrame, Valentina; Pozza, Gioia; DALLA BONA, Enrico; Fantin, Alberto; Valmasoni, Michele; Sperti, Cosim

Solid-Pseudopapillary Tumor of the Pancreas: A Single Center Experience

Aim of this study was to review the institutional experience of solid-pseudopapillary tumors of the pancreas with particular attention to the problems of preoperative diagnosis and treatment. From 1997 to 2013, SPT was diagnosed in 18 patients among 451 pancreatic cystic neoplasms (3.7%). All patients underwent preoperative abdominal ultrasound, computed assisted tomography, and tumor markers determinations. In some instances, magnetic resonance, positron emission tomography, and endoscopic ultrasound with aspiration cytology were performed. There were two males and 16 females. Serum CA 19-9 was slightly elevated in one case. Preoperative diagnosis was neuroendocrine tumor ( = 2), mucinous tumor ( = 2), and SPT ( = 14). Two patients underwent previous operation before referral to our department: one explorative laparotomy and one enucleation of SPT resulting in surgical margins involvement. All patients underwent pancreatic resection associated with portal vein resection ( = 1) or liver metastases ( = 1). One patient died of metastatic disease, 77 months after operation, and 17 are alive and free with a median survival time of 81.5 months (range 36-228 months). Most of SPT can be diagnosed by CT or MRI, and the role of other diagnostic tools is very limited. We lack sufficient information regarding clinicopathologic features predicting prognosis. Caution is needed when performing limited resection, and long and careful follow-up is required for all patients after surgery

Continuous erector spinae plane block for pain management in laparoscopic liver resection: case report

Pain after liver resection can be difficult to manage. Epidural anesthesia (EA) isaneffective technique inpain control inthis surgery. However, postoperative coagulopathy and hypotension due to autonomic nervous system block in high-risk patients, may result that the EA is an inadequate analgesic technique in according to enhanced recovery after surgery (ERAS) recommendations for liver surgery. Regional block techniques have been recommended for liver surgery in ERAS guidelines. Erector spinae plane (ESP) block is a recent block described for thoracic and abdominal surgeries and provides both somatic and visceral analgesia. We describe a high-risk patient with cardiac dysfunction and Parkinson's disease who underwent laparoscopic right liver resection for hepatocellular carcinoma. Satisfactory intra and postoperative analgesia was achieved by a combined continuous ESP block, transversus abdominis plane (TAP), and oblique subcostal TAP blocks. Surgery and postoperative period was uneventful. No opioids were administered during hospitalization. A combined of thoracic and abdominal wall blocks can be an effective approach for intra and postoperative analgesia in highrisk patients undergoing laparoscopic liver resection. Further clinical research is recommended to establish the effectiveness of the ESP block as an analgesic technique in this surgery

Fatal pneumococcal sepsis eleven years after distal pancreatectomy with splenectomy for pancreatic cancer

Overwhelming post-splenectomy sepsis is defined as septicaemia and/or meningitis, usually fulminant, occurring days to several years after removal of the spleen. We report a case of a fulminant pneumococcal sepsis with a fatal outcome, occurring 11 years after distal pancreatectomy and splenectomy for pancreatic adenocarcinoma

Effects of dietary protein and lysine content on growth performances, carcass traits and estimated nitrogen input-output flow of growing pigs

This study was aimed to evaluate the effects of crude protein (CP) and standardized ileal digestible (SID) lysine on the performance of growing pigs of two commercial crossbreds (A and B) from 30 to 145 kg BW. The pigs (30.4 \ub1 2.0 kg of initial BW) were allotted in 8 pens (6 A and 6 B per pen) and received until around 60kg BW the same diet containing 164g/kg CP and 11.0g/kg SID lysine. Afterwards, pigs of 4 pens were fed diets containing 163 to 146 g/kg CP and 9.4 to 8.5g/kg SID lysine (HP), whereas the others were fed diets containing 158 to 126 g/kg CP and 8.0 to 6.5 g/kg SID Lys (LP). Individual feed intake was recorded daily by automated feeding stations (Compident Pig - MLP, Shauer Agrotronic, Austria) and animals were weighed weekly from the start to the end of the trial (145\ub16.2kg BW). From 60kg BW onwards, the P2 subcutaneous fat thickness (P2BF) of all pigs was measured by ultrasound scanner equipped with a 5.5\u201310.5MHz linear probe (Mylab OneVET - ESAOTE S.p.A., Genova, Italy), with a 3-week interval. The nitrogen (N) input-output flow was computed as difference between N intake and N retention, estimated either assuming a reten- tion of 24 g N/kg BW or using the relationships between BW, P2BF and the estimated body protein content. At laughterhouse, carcasses and main cuts were weighed and individual samples of longissimus lumborum were collected for chemical and physical analysis. Data were analysed according to a two way factorial mixed model including the effects of diet, crossbreds, their interaction and the random effect of pen within diet. Average growth rate of pigs in the 30 to 145kg BW interval exceeded 0.95kg/d, with an average feed conversion ratio of 2.57. Pigs fed LP diet showed similar growing performance and carcass and meat quality traits when compared to HP fed pigs, but a significant (p<.001) lower N intake and a significant (p<.001) lower estimated N excretion, irrespective of the method used for N retention prediction. Even if crossbreds differentiated (p<.05) for growth rate, feed intake and feed efficiency, no interaction was detected between CP/SID lysine dietary content and pig genetic line. In conclusion, an average reduction of 10 to 20% of CP and SID lysine dietary content did not impair pig per- formance, but greatly reduced the N output and the inclusion of soybean meal in the diets. This response does not seem affected by the genetic type of pigs. Study supported by University of Padova (DOR1638484/16) and Regione Veneto under grant P.O.R. - F.S.E. n. 2105-41- 2121-2015. The authors acknowledge Veronesi SpA (Quinto di Valpantena, Verona, Italy) for financial and technical support

Neoadjuvant Treatment in Resectable Pancreatic Cancer. Is It Time for Pushing on It?

: Pancreatic resection still represents the only curative option for patients affected by pancreatic ductal adenocarcinoma (PDAC). However, the association with modern chemotherapy regimens is a key factor in improving the inauspicious oncological outcome. The benefit of neoadjuvant treatment (NAT) for borderline resectable/locally advanced PDAC has been demonstrated; this evidence raises the question of whether even resectable PDAC should undergo NAT rather than upfront surgery. NAT may avoid futile surgery because of undetected distant metastases or aggressive tumor biology, providing more effective systemic control of the disease, which is hampered when adjuvant chemotherapy is delayed or precluded. However, recent data show controversial results regarding the efficacy and safety of NAT in resectable PDAC compared to upfront surgery. Although several prospective studies and meta-analyses indicate better oncologic outcomes after NAT, there are some biases, such as the methodological approaches used to capture the events of interest, which could make these results hardly reproducible. For instance, per-protocol studies, considering only the postoperative outcomes, tend to overestimate the performance of NAT by excluding patients who will never be suitable for surgery due to the development of chemotoxicity or tumor progression. To draw reliable conclusions, the studies should capture the events of interest of both strategies (NAT/upfront surgery) from the time of allocation to a specific treatment in an intention-to-treat fashion. This critical review highlights the current literature data concerning the use of NAT in resectable PDAC, summarizing the results of high-quality studies and focusing on the methodological issues of the most recent pieces of evidence

Indocyanine Green Fluorescence Navigation in Liver Surgery: A Systematic Review on Dose and Timing of Administration

Background: Indocyanine green (ICG) fluorescence has proven to be a high potential navigation tool during liver surgery; however, its optimal usage is still far from being standardized. Methods: A systematic review was conducted on MEDLINE/PubMed for English articles that contained the information of dose and timing of ICG administration until February 2021. Successful rates of tumor detection and liver segmentation, as well as tumor/patient background and imaging settings were also reviewed. The quality assessment of the articles was performed in accordance with the Scottish Intercollegiate Guidelines Network (SIGN). Results: Out of initial 311 articles, a total of 72 manuscripts were obtained. The quality assessment of the included studies revealed usually low; only 9 articles got qualified as high quality. Forty articles (55%) focused on open resections, whereas 32 articles (45%) on laparoscopic and robotic liver resections. Thirty-four articles (47%) described tumor detection ability, and 25 articles (35%) did liver segmentation ability, and the others (18%) did both abilities. Negative staining was reported (42%) more than positive staining (32%). For tumor detection, majority used the dose of 0.5 mg/kg within 14 days before the operation day, and an additional administration (0.02-0.5 mg/kg) in case of longer preoperative interval. Tumor detection rate was reported to be 87.4% (range, 43%-100%) with false positive rate reported to be 10.5% (range, 0%-31.3%). For negative staining method, the majority used 2.5 mg/body, ranging from 0.025 to 25 mg/body. For positive staining method, the majority used 0.25 mg/body, ranging from 0.025 to 12.5 mg/body. Successful segmentation rate was 88.0% (range, 53%-100%). Conclusion: The time point and dose of ICG administration strongly needs to be tailored case by case in daily practice, due to various tumor/patient backgrounds and imaging settings